Star Spangled Sprint Registration Survey

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1. Name

Name

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2. Gender

Gender Female

Male

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3. Address

Address

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4. Email

Email

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5. Age

Age

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6. Do you have a child participating in the Fun Run? (Ages 12 and under)

Do you have a child participating in the Fun Run? (Ages 12 and under) Yes

No

7. How many children ages 12 and under will be participating in the Fun Run?

How many children ages 12 and under will be participating in the Fun Run? 0

1

2

3

4

5

Over 5

8. Are you a veteran?

Are you a veteran? Yes

No

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9. Upon completion of this online registration, I hereby waive and release Southeastern Community College or any individuals or organizations who assist or support the Star-Spangled 5k Walk/Run and Kids Fun Run from any liability from illness or injuries I may suffer as a direct or indirect result of my participation. I further state that I am in proper physical condition to participate in this event and I understand that running a race is a potentially hazardous activity. I consent to be treated by licensed medical personnel if an emergency occurs, although Southeastern Community College will have no liability for payment of any costs of such treatment. I understand and agree that the decision of the officials is final.

Upon completion of this online registration, I hereby waive and release Southeastern Community College or any individuals or organizations who assist or support the Star-Spangled 5k Walk/Run and Kids Fun Run from any liability from illness or injuries I may suffer as a direct or indirect result of my participation. I further state that I am in proper physical condition to participate in this event and I understand that running a race is a potentially hazardous activity. I consent to be treated by licensed medical personnel if an emergency occurs, although Southeastern Community College will have no liability for payment of any costs of such treatment. I understand and agree that the decision of the officials is final. Yes

No